View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1615-0114	ICR Reference No: 202007-1615-029
Status: Historical Active	Previous ICR Reference No: 202005-1615-001
Agency/Subagency: DHS/USCIS	Agency Tracking No: I-910
Title: Application for Civil Surgeon Designation
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/30/2020
	Date Received in OIRA: 08/06/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2022	07/31/2022	07/31/2022
Responses	470	0	470
Time Burden (Hours)	940	0	940
Cost Burden (Dollars)	24,205	0	24,205

Annual Cost to Federal Government: $368,950

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Melanie Frank 202 527-4488 melanie.r.frank2@uscis.dhs.gov

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